RICK: Sarah, I remember that story on school health centers, and one memorable phrase coming from the school nurse in the story was "booboos and band aids," kind of suggesting that school nurses aren't qualified to deal with much more than just trivial injuries or illnesses.

SARAH: Right, kids coming in with minor scrapes, they'd get a band aid… or throwing up, maybe they'd have their temperature taken and a call would go out to the parents to take them home.

RICK: That's how I remember it. What's changed?

SARAH: Those incidents still occur, but there are many other issues as well. Here's Debbie Aloshen, the head nurse of the Cleveland school district. I spoke to her at Mound elementary, at that first MetroHealth school clinic, and she's made it a mission over the past several months to explain to me how hard her nurses work and the reality they deal with every day.
"Kids come in with diabetes, major seizure disorders, psychological problems, problems whether it's mental physical, emotional and we see them all," Aloshen says. "We are the front line for many, many things."

SARAH: And it's the same story in school districts across Ohio. And not just urban ones - kids in lots of suburban and rural areaS also have chronic health issues.

Now, to gain a better understanding of whether school district across the country are coping with the same rise in health concerns, I called the National Association of School Nurses. Beth Mattey, the president-elect of that organization talked to me from her office in Texas. She says the role of the school nurse has simply changed.

"There are 10 million children that have asthma and, you know, they come to school and need to be managed with their asthma so they don't end up having to go back to the doctors office so frequently. Children with peanut allergies has doubled from 1997 to 2002," Mattey says.

SARAH: She goes on to talk about the rise in diabetes and points out that right now 13 to 18 percent of adolescents nationwide have some sort of chronic health condition.

RICK: So if there's so much more that nurses are responsible for handling, do they need any additional training or credentials?

School nurses are typically registered nurses or licensed practical nurses. In recent years, associations like NASN and Ohio's Association of School Nurses have lobbied for states to require additional certification and training.

RICK: What has caused this increase in illnesses among children.

SARAH: There are many reasons, and we have discussed some of them here, including lifestyle choices that lead to obesity, which then has a host of associated illnesses like diabetes. But Mattey also gave another reason that I had never thought about.

"Babies are surviving younger. You know, 26-week old babies are surviving and these children are growing up and going to school. They may have tube feeding, they may need a ventilator. Things like that we are seeing more of in our schools," Mattey says.

SARAH: It's amazing what medicine can do to save lives, but as Mattey explains, that often means living with long-term disabilities. And, as result, there are more disabled children attending schools than decades ago.

RICK: At most schools, it's the nurse who would take care of those tube feedings and monitor their ventilators?

SARAH: That's right. And one final parting thought: Many school districts consider cutting nurses when budgets get tight.